1. Field of Invention
The present invention relates to surgical procedures and apparatus, and more specifically to a self-retaining retractor and surgical method of using a self-retaining retractor at a surgical site.
2. Background of Invention
Surgical “retraction” is the drawing back of body tissue. When a surgical procedure involves making an incision, the incision site itself often must be retracted in order for the surgery to proceed through completion. During surgery, internal organs, bones, and tissues are intermittently retracted through the opening created in the retracted incision site.
In certain surgeries, an assistant's fingers are used as retractor paddles to hold the site of the incision open. However, greater technical ease is available through the use of various mechanical retractor systems. Such mechanical retractor systems can be divided into two major groups: externally mounted “fixed” to the operating table and self-retaining retractors.
Mechanical systems attached to the operating table present the same type of physical obstruction to the movements of the surgeon as presented by the assistant's body, arms, and hands since the externally fixed retractor system consists of a vertical column, supporting ring or arms and retractor paddles attached thereto. All components of the fixed retractor system are adjustable in multiple planes and axes of motion. These components, however, are not independently adjustable in the vertical plane; movement of a ring or support arm of the fixed retractor system necessitates movement and adjustment of all retractor paddles attached thereto.
Ideally, mechanical tissue retractors, both externally mounted and self retaining, need to provide for internal organ, bone, and tissue retraction. Both types of retractor systems need to be quickly and easily assembled, positioned, and repositioned in all planes and axes of motion, and present as little obstruction as possible to the surgeons movements and line of sight. Both types of retractor systems must protect the sterile field, diminish the risk of tissue trauma and still remain sufficiently stable to function properly without the need for assistance.
Self-retaining retractors have attempted to provide for internal organ and tissue retraction through the open incision, but have failed to permit quick, independent, easy and safe adjustment of internal organ and tissue retractor arms in all planes and axes of motion. Furthermore, self-retaining retractors have failed to provide an internal support mechanism for bone, organs, and tissue within the incision site, making the prior art ineffectual, unsafe, or both. Existing self-retaining retractors are not readily or easily adjustable in the vertical plane and must traverse through or over internal tissue before reaching the optimal location for the surgical procedure.
Various patents have issued relating to surgical retractors. U.S. Pat. No. 5,520,610 issued to Giglio on May 28, 1996 describes a self-retaining retractor that includes flexible, resilient retractor paddles which can be placed into the incision. A rigid frame includes two interlocking halves that lay over the incision longitudinally. The incision retractor paddles are manually clipped to each frame half and the frame halves may then be opened to the extent of tissue retraction desired.
U.S. Pat. No. 6,074,343 issued to Nathanson et al. on Jun. 13, 2000 describes a surgical incision retractor to be used in small tissue incisions and includes a plurality of blades that can be operated simultaneously or at least one or more blades can be operated independently. Right and left retractor blades are mounted on an actuator mechanism that spreads or expands the blades as a rotatable primary actuator knob is rotated. A third retractable arm is mounted for simultaneous operation with the right and left retractor blade or independent operation through a secondary rotatable actuator knob that extends or retracts a threaded shaft attached to the center retractor blade.
U.S. Pat. No. 7,022,069 issued on Apr. 4, 2006 to Masson and Henry describes a circumferential retractor apparatus including a first retractor paddle, a second retractor paddle and an elastic member. Each of the first and second retractor paddles includes a body portion with an arm extending outwardly therefrom. The arm supports a grasping surface. The arm of the retractor paddle has a hole formed therein through which the elastic member passes.
On Jun. 25, 2002, Masson and Henry were granted U.S. Pat. No. 6,409,731 describing a bone leveler or apparatus that includes a first blade member having a forward end suitable for contacting the bone and a rearward end, a second blade member having a forward end suitable for contacting the bone and a rearward end, and an elastic member having one end received by the first blade member and an opposite end received by a second blade member. Each of the blade members has an identical configuration. Each of the blade members has a hole formed between the forward end and rearward end. The elastic member has one end received by the hole of the first blade member and an opposite end received by the hole of the second blade member.
A typical procedure generally involves an operating team of trained practitioners that includes a surgeon and at least one assistant or more, depending on the complexity of the operation. Once an operation site is sterile, as recommended, and the operating team and patient prepped, a surgeon will usually make a predetermined incision of integument, such as skin, in order to view and access a predetermined region of the patient's body.
A tool typically used in the medical field to create and maintain an aperture is commonly referred to as a retractor. A basic retractor comprises a blunt object—or other form object that will not perforate, deform, or compromise an incised edge—and is generally referred to as an paddle or arm (as referenced herein). The arm may be similar in width to the width of an incision and of a length sufficient to be inserted through an incision to a desired depth of a patient's body while capable of being manipulated from outside the patient's body. Force is usually applied to a portion of an inserted arm, distal to incised edges, which causes integument to separate or retract, thus forming an aperture.
Depending on the degree of surgical procedure that is performed, an aperture may need to be maintained for a short period of time or for hours. It is not uncommon for a practitioner to use a finger as an arm or other object to retract and retain integument. This practice requires constant manual/physical force and can be undesirable because the finger may obstruct a surgeon's view, may fatigue, or may be distracted and move which can result in injury to a practitioner or patient. Therefore, when manual retractors are avoided, practitioners may use mechanical arms to separate integument and maintain an aperture.
Mechanical retractors generally involve connecting an arm to a stationary object outside the incision, like an operating table, hanger, or frame supported by a patient. This type of retractor has been known to cause obstruction to practitioners and even injury to a patient if they move during surgery or when a time consuming disassembly is required in an emergency situation.